2015年 · 第31卷第07期

Calcium and phosphorus metabolism disorders caused by chronic renal insufficiency, especially phosphorus metabolism disorders, are common complications in patients with maintenance hemodialysis (MHD), and are also a risk factor for high incidence of cardiovascular events. Left ventricular hypertrophy (LVH) is the most common cardiac structural change in patients with MHD and is a contributing factor to high cardiovascular mortality^[1]。 To further understand the relationship between phosphorus metabolism disorders and LVH, we conducted a cross-sectional study of 150 patients with MHD, which is now reported below.

A total of 167 peritoneal dialysis patients followed up in our center from October 2008 to September 2014 were retrospectively analyzed, including 73 patients (108 cases) hospitalized due to peritoneal dialysis-related infectious peritonitis, to understand the pathogenic bacteria and drug susceptibility of peritonitis in our center in the past 6 years, and to analyze the relationship between pathogens and prognosis, so as to provide evidence for the prevention and treatment of peritonitis.

Percutaneous renal biopsy (renal biopsy) is an indispensable invasive examination for the diagnosis of glomerular diseases, and the operation is relatively simple and safe. The incidence of complications varies depending on the degree of proficiency of each unit in mastering the indications for kidney biopsy and the technique of kidney biopsy physicians. The incidence rate of common renal biopsy complications is about 3.5% ~13.0%^[1], generally manifested as macroscopic hematuria and perirenal hematoma. The incidence of serious complications was 0.75% to 1.40%^[2]。 Accessory renal artery is the most common anatomical variation of renal blood supply artery. Multiple accessory renal arteries of different origins enriched the local blood flow in the lower pole of the right kidney, which originally lacked blood supply, resulting in a rare perinephral hematoma in renal biopsy, which is reported below.

The variation of radial artery running is rare, and the radial artery running opposite to the dorsal side of the radius is called "anti-Guan vein". There have been no reports of "anti-Guanmai" autologous arteriovenous fistula surgery in China. The case report of our "anti-Guanmai" autologous arteriovenous fistula operation is as follows.

Complement regulatory proteins are a class of proteins involved in regulating the activation of the complement system and affecting its effects, including CD59, CD55, CR1, CD46, etc. They play a similar inhibitory role in the key steps of the complement activation chain, thereby protecting tissue cells from complement destruction. CD46 is a member of complement regulatory proteins. It was initially found that it can help factor I to inhibit the formation of C3 convertase. With the deepening of understanding of CD46, it is currently considered as a membrane protein with multiple functions. The occurrence of kidney diseases is mostly related to immune factors. As an important part of the immune system, the complement system is widely involved in immune regulation and inflammatory response. As a regulatory point of the key steps of the complement system, the complement regulatory protein CD46 plays a role in the occurrence and development of kidney diseases.

Vascular calcification is one of the common serious complications in patients with chronic kidney disease (CKD), and it is also an important indicator to predict the occurrence of cardiovascular complications and death in patients with CKD and maintenance hemodialysis (MHD). Vascular calcification can be divided into two types: intimal and media calcification. Intimal calcification refers to diffuse atherosclerosis, while media calcification refers to localized calcium deposition occurring in the media of blood vessels, which is independent of atherosclerosis risk factors. The site of vascular calcification is associated with the clinical symptoms that occur. This article reviews the main pathogenesis, preventive measures and treatment progress of vascular calcification in MHD patients.

Diabetic nephropathy is a diabetic microvascular complication that can progress to renal failure and is a major cause of end-stage renal disease. More and more evidence shows that epigenetic mechanisms regulate the gene transcription process of target organ cells, leading to the activation of inflammatory response genes and multiple related signaling pathways, which are involved in the formation and progression of diabetic nephropathy^[1,2,3]。 Epigenetic mechanisms include DNA methylation, histone modification and Micro RNA. Post-translational modifications of histones occur in the N-terminal tail of histones, including methylation, acetylation, phosphorylation, ubiquitination and ADP ribosylation. These modifications affect the transcription of genes by regulating the elastic structure of chromatin or recruiting specific proteins^[4]。 Study finds altered epigenetic modification patterns in diabetic patients^[5]For example, histone acetylation modification in peripheral blood mononuclear cells of patients with type 2 diabetes is abnormal^[6]Inflammatory response gene promoter acetylation levels are increased and inflammatory response gene expression is upregulated^[7]； Outbreak type 1 diabetes^[8]Adult occult autoimmune diabetes mellitus^[9]The promoter region of Foxp3 gene was hypermethylated in peripheral blood mononuclear cells of patients, and the expression of Foxp3 was down-regulated. Post-translational modification of histone is involved in regulating the expression of genes related to diabetic nephropathy, and plays an important role in the vascular complications of diabetes mellitus.